American Society for Peripheral Nerve

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Intraoral Approach for Facial Reanimation
Sinikka Suominen, MD, PhD; Tuija Ylš-Kotola, MD, PhD
Helsinki University Hospital, Helsinki, Finland

Background: If the facial muscles can be reinnervated in time before atrophy and permanent damage, the patients may regain some if not all of their facial movements. The problem with cross-face grafting is time, it often takes the nerve too long to grow to reach the affected site, and babysitter procedures have been proposed. Inspired by Dr Koshimas experience, we started to use an intraoral approach to cross face grafting to shorten the distance between the donor and recipient nerves to have a more rapid recovery.

Methods: In our series of 7 patients, 4 had sural nerve grafting from a buccal branch to a buccal branch, 3 had the same using a vascularized nerve graft from the anterior thigh and 4 of the 7 had a combination of both end-to side masseter nerve transposition and buccal-to buccal grafting. No facial woulds are created, only inraoral in the sulcus on both sides.

Results: Sural grafting alone produced less or no results, and the combined approach was the most effective, EMNG at 1 years revealed a working connection to the healthy facial nerve providing natural facial movements.

Conclusions: A complete facial palsy is a surgical challenge. If the facial muscles can be reinnervated  the result is three dimensional and superior to free muscle transfer. This new approach seems to shorten the recovery time with no facial scars.

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